Labor and Birth Flashcards
How is the first stage of pregnancy characterized and what are the three phases?
- Onset of labor until full dilation and effacement (10 cm/100%)
- Three phases: latent, active, transition
How is the second stage of pregnancy characterized?
- Full dilation and effacement until birth of fetus
- Stretch receptors in pelvic floor activated as fetus passes through pelvis
When is the third stage of pregnancy?
From birth of fetus until delivery of placenta
When is the fourth stage of pregnancy?
From delivery of placenta until 2 hours postpartum
What does true labor look like?
- bloody show
- contractions felt in back and abdomen
- contractions get longer/stronger/closer together
- progressive cervical change
- ROM (rupture of membranes)
What does false labor look like?
- contractions mostly felt in lower abdomen
- contractions have little to no pattern and do not get stronger
- contractions stop with hydration or activity
- no cervical change
What are the three questions to ask during initial assessment (triage)?
- How is baby moving?
- Are you having any vaginal bleeding?
- Are you leaking any fluid?
What kind of data is collected during initial assessment of laboring patient?
- Three questions!
- What is their indication for labor (contractions, rupture of membranes (ROM), etc.)
- Fetal heart rate and contraction assessment (frequency, duration, intensity, rest)
- Cervical exam (dilation, effacement, station, and presenting part)
- Vital signs
- Thorough past medical and surgical history
- Any issues with current pregnancy (hypertension, diabetes, etc.)
- Current medication use
- Allergies
- Assessment (heart, lungs, edema, DTRs, etc.)
What are the 4 P’s that impact labor progression?
- Passenger (fetus)
- Passageway (birth canal)
- Powers (contractions)
- Psychologic response
What are the four categories of Passenger?
Presentation:
- Cephalic
- Breech
- Shoulder
Fetal head:
- Size
- Molding
Fetal lie:
- Long axis of fetus (spine) in relation to long axis of birthing parent (spine)
Fetal attitude:
- How flexed is the fetal head to its body? A flexed head navigates pelvis more efficiently
What is the ideal positioning of the fetal head during a vaginal birth?
- Baby is chin to chest
- Cephalic presentation is ideal (head down, chin tucked to chest, facing mom’s back)
- Vertex presentation is the preferred subtype
What does Passageway consist of?
- Bony pelvis
- Cervix
- Pelvic musculature
- Vagina
What is occurring during Power?
- 1st stage of labor
- dilate and thin (efface) the cervix
- 2nd stage of labor
- expel fetus (urge to bear down)
Describe Psychological response.
- Overall emotional response to pregnancy
- Previous pregnancies/births/children
- Support system
- Prenatal education and coping abilities
- Cultural factors
- Emotions may fluctuate throughout labor
What are the types of external fetal monitoring?
- Ultrasound monitors fetal heart rate
- Tocometer (toco) measures frequency and duration of contractions
